[Intl_DxMedPhys] Heads up on NEJM paper on radiation exposure in peds and hematologic cancer risk

Wed Sep 24 16:33:46 EDT 2025

Dave: FWIW, I agree completely.

Rebecca Milman

On Wed, Sep 24, 2025 at 11:03 AM Dave Jordan via Intl_dxmedphys_wd_osu_list
<intl_dxmedphys_wd_osu_list at lists.osu.edu> wrote:

> From a clinical physicist standpoint, let’s try a thought experiment.
> Suppose that regardless of the quality of the science or our criticisms of
> it, the essential conclusions of this paper will end up driving or guiding
> our field. I do think
> From a clinical physicist standpoint, let’s try a thought experiment.
> Suppose that regardless of the quality of the science or our criticisms of
> it, the essential conclusions of this paper will end up driving or guiding
> our field. I do think that will end up happening to some extent, given the
> “first-mover” effect of this research having been published with high
> visibility in one of the top journals not just in radiology but all of
> medicine. Any responses from professional organizations will be reactive
> and much less visible than the paper itself.
>
> Given that background, what can we, and should we, do about it as medical
> physicists proactively, *before* that decision is made for us and we are
> forced to react? I believe we will make better decisions proactively than
> what would be forced upon us by knee-jerk action of less-expert
> authorities, and you can bet that hospital presidents and physician leaders
> (I’m talking CMOs, not Radiology chairs) are going to want to “get in front
> of this."
>
> This paper isn’t going to spell the end of CT by any means. Even if you
> accept the risks described in this paper as accurate, the medical benefits
> when a scan is medically appropriate are several orders of magnitude larger.
>
> However, if we don’t want to get dragged down by a barrage of questions
> and challenges about radiation dose, we could approach this by assuming the
> paper is right, deciding what we would do if that were the case, and taking
> proactive steps to address those concerns and make improvements. Then
> instead of reacting and being jerked around by the inevitable questions,
> we’re in a position to say “thanks, we’re aware of it, already working on
> it, and here’s what we’ve done/are doing.” This lets us stay in the
> driver’s seat to maintain image quality and diagnostic utility instead of
> getting swept along in the obsession with reducing and avoiding radiation
> dose.
>
> ---
> On Sep 24, 2025 at 10:40 AM -0400, Gao, Yiming via
> Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu>,
> wrote:
>
> Hi Kai, I think there are many unanswered questions for this published
> paper. Here are my thoughts: Apparently they used the UF/NCI phantom
> library to match patients to phantoms and compute organ and effective
> doses. They mentioned “missing
>
> Hi Kai,
>
>
>
> I think there are many unanswered questions for this published paper. Here
> are my thoughts:
>
>
>
>    1. Apparently they used the UF/NCI phantom library to match patients
>    to phantoms and compute organ and effective doses. They mentioned “missing
>    height or weight” in both US and Canadian exams, and the matching process
>    is yet based on height and weight. They filled in the missing data with
>    median values, but the questions are: (1) how much percentage of the
>    dataset is missing height and weight, (2) have they tried different filling
>    methods and compared the outcome, (3) can they use effective diameter
>    instead of height & weight for matching and how different the outcome would
>    be?
>    2. They mentioned exams missing CT acquisition parameters and just
>    filled them randomly by using a multilevel random effects model, so again
>    (1) how much percentage is missing the parameters, (2) have they tried
>    different models and (3) can they use a different filling method.
>    3. They mentioned “One U.S. site was unable to abstract individual CT
>    dose”. I’m assuming they are talking about CTDIvol here, so again (1) how
>    much percentage is missing CTDIvol, (2) how did they fill in the missing
>    data for CTDIvol. They also mentioned a “random forest model” which filled
>    in missing technical parameters, so is it the same model as the “multilevel
>    random effects model” in point 2?
>
>
>
> In terms patient demographics, CT acquisition parameters, and CTDIvol (“CT
> dose”), there are many unanswered questions and their models for filling
> the missing parameters are unclear and unverified. I wonder how this paper
> got through the reviewers and editors…
>
>
>
> Best wishes,
>
> Yiming Gao,
>
> Assistant Attending Physicist,
>
> MSKCC
>
>
>
> *From:* Intl_dxmedphys_wd_osu_list
> <intl_dxmedphys_wd_osu_list-bounces+gaoy1=mskcc.org at lists.osu.edu> *On
> Behalf Of* Yang, Kai, PhD via Intl_dxmedphys_wd_osu_list
> *Sent:* Wednesday, September 24, 2025 9:52 AM
> *To:* Mark Supanich <Mark_Supanich at rush.edu>; Jerry Thomas <
> jerry.thomas at ascension.org>
> *Cc:* intl_dxmedphys_wd_osu_list at lists.osu.edu
> *Subject:* Re: [Intl_DxMedPhys] [EXTERNAL] Re: Heads up on NEJM paper on
> radiation exposure in peds and hematologic cancer risk
>
>
>
> Hi everyone, as I am reading through the appendix 1 for that paper, it
> turned out that they didn't even have most of the real dose data, but other
> than "guessing it out"? Below is the exact text, would love to hear what
> others think.
>
> Hi everyone, as I am reading through the appendix 1 for that paper, it
> turned out that they didn't even have most of the real dose data, but other
> than "guessing it out"? Below is the exact text, would love to hear what
> others think.
>
> Hi everyone, as I am reading through the appendix 1 for that paper, it
> turned out that they didn't even have most of the real dose data, but other
> than "guessing it out"? Below is the exact text, would love to hear what
> others think.
>
>
>
> <image001.png>
>
>
>
> <image002.png>
> ------------------------------
>
> *From:* Intl_dxmedphys_wd_osu_list <
> intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> on behalf of Jerry
> Thomas via Intl_dxmedphys_wd_osu_list <
> intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Sent:* Monday, September 22, 2025 12:11 PM
> *To:* Mark Supanich <Mark_Supanich at rush.edu>
> *Cc:* intl_dxmedphys_wd_osu_list at lists.osu.edu <
> intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Subject:* Re: [Intl_DxMedPhys] [EXTERNAL] Re: Heads up on NEJM paper on
> radiation exposure in peds and hematologic cancer risk
>
>
>
> Mark and Baojun, Great points. Both need to be in a letter to the editor.
> Unfortunately, the reviewers of this paper failed to do their job. -- They
> were either, biased in favor of the paper's conclusions, busy and did not
> read the paper
>
> *        External Email - Use Caution        *
>
> Mark and Baojun,
>
>
>
>       Great points.  Both need to be in a letter to the editor.
> Unfortunately, the reviewers of this paper failed to do their job.  -- They
> were either, biased in favor of the paper's conclusions, busy and did not
> read the paper critically, or were reviewing work that they were not
> qualified to review.  Regardless this paper will be quoted, so it is now
> imperative that a letter to the editor be written.  I would enjoy reading
> the response to the letter. --- especially the support for hormesis that
> Mark pointed out.
>
>
>
>
>
> Jerry Thomas, MS, FAAPM, DABR, CHP, DABSNM
>
> Diagnostic Medical Physicist / Radiation Safety Officer
>
> Ascension Via Christi Hospitals Wichita
>
> Wichita, KS  67214
>
>
>
> Phone:  316-268-5958  (office)
>
>             240-447-1014  (cell)
>
>
>
>
>
> On Fri, Sep 19, 2025 at 3:18 PM Mark Supanich via
> Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu>
> wrote:
>
> An interesting note on this is that they also could have claimed that low
> levels of ionizing radiation have a positive impact on hematologic cancer
> rates. They cancer incidence rate (cases per 10,000 in their cohort) was
> lower for groups receiving
>
> An interesting note on this is that they also could have claimed that low
> levels of ionizing radiation have a positive impact on hematologic cancer
> rates. They cancer incidence rate (cases per 10,000 in their cohort) was
> lower for groups receiving between 5-15 mGy dose to the bone marrow than
> the group with no medical imaging. Their own calculated ERR was even <1 for
> the 5-10 mGy group.
>
>
>
> I wonder why the headlines aren't: "exposure to low levels of ionizing
> radiation protects children from blood cancer"?
>
> [image: Beaming face with smiling eyes]
>
>
>
>
> ------------------------------
>
> *From:* Intl_dxmedphys_wd_osu_list <
> intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> on behalf of Li, Baojun
> via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Sent:* Friday, September 19, 2025 1:01 PM
> *To:* intl_dxmedphys_wd_osu_list at lists.osu.edu <
> intl_dxmedphys_wd_osu_list at lists.osu.edu>
> *Subject:* Re: [Intl_DxMedPhys] Heads up on NEJM paper on radiation
> exposure in peds and hematologic cancer risk
>
>
>
> Rush Email Security
>
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>
> If we replace “accumulative dose to bone marrow” with “total number of
> blood draws or hospital visits,” the relationship would likely still hold.
> By the authors’ reasoning, one could then conclude that blood draws or
> hospital visits cause cancer?!
>
> If we replace “accumulative dose to bone marrow” with “total number of
> blood draws or hospital visits,” the relationship would likely still
> hold. By the authors’ reasoning, one could then conclude that blood draws
> or hospital visits cause cancer?!
>
>
>
> In reality, children who undergo multiple CT examinations typically do so
> because of more severe or complex medical conditions. These patients are
> inherently predisposed to more hospital encounters and already have a
> higher baseline risk of hematologic malignancies, independent of imaging.
> The causal inference presented by the authors is deeply flawed and
> misleading.
>
>
>
> Thanks,
>
> Baojun
>
>
>
>
>
> *From:* Intl_dxmedphys_wd_osu_list
> <intl_dxmedphys_wd_osu_list-bounces+baojunli=bu.edu at lists.osu.edu> *On
> Behalf Of* Mark Supanich via Intl_dxmedphys_wd_osu_list
> *Sent:* Wednesday, September 17, 2025 6:35 PM
> *To:* intl_dxmedphys_wd_osu_list at lists.osu.edu
> *Subject:* [Intl_DxMedPhys] Heads up on NEJM paper on radiation exposure
> in peds and hematologic cancer risk
>
>
>
> Hi all, Just a heads up that NEJM published a paper from Smith-Bindman et
> al this afternoon. https: //www. nejm. org/doi/full/10. 1056/NEJMoa2502098?query=featured_home
> It’s an observational study of 3. 5+ million peds looking at cumulative
>
> Hi all,
>
>
>
>
>
> Just a heads up that NEJM published a paper from Smith-Bindman et al this
> afternoon.
> https://urldefense.com/v3/__https://www.nejm.org/doi/full/10.1056/NEJMoa2502098?query=featured_home__;!!KGKeukY!ynY2WVhoYgDAmFyWT9lFAfFdq0-Xg6yya5SAWg6Z44i-T-5ckDWriCsEBJJ3xn6Amhpmp69MuFPdDjE7yse7fGRD-3g96AWhFq6Z$ 
> <https://urldefense.com/v3/__https:/secure-web.cisco.com/1Pif7c1GVQLMo413q8lyswy_kWQJLqJ3cKx0nQGFkr6roy5XKcaHcgKgfMCEavkXWhlxS8ojxDPVSFGiV159HoqVJmU1jBGSWxEki9pZnNPgFOXuWFFH2cPJ9iESxUtrQHf_ftWuSrAwDenu0XEKs0so3Lp9yPyDyGAV3HvnkyA-TrzcHTi9F93RdM-0fHk1giADz-zhQumMlFKwrrYAqW8VJgUXlHogYD3wj7r1dcf4yGekHSraexmKvdaXr30d08r8i_6QvavJrM510aQFokDAKVMk1V0aM93CarLhqDapQA4xODAM2K6B2mOQ4qdXk/https*3A*2F*2Furldefense.com*2Fv3*2F__https*3A*2Fwww.nejm.org*2Fdoi*2Ffull*2F10.1056*2FNEJMoa2502098*3Fquery*3Dfeatured_home__*3B*21*21KGKeukY*211m_oRWHMFCepm1fT1RIhzq46cPRXjfbhAvYKAO_5iNUOWD5mqN0G-iBdtAZYZy1h5_JOVRouzbgwoLM5N75lJAFaFMiQA3UTRzxHR2RjJ7wH4P8*24__;JSUlJSUlJSUlJSUlJSUlJSUl!!KGKeukY!yZPKhr2mTtVY5J4oB8YS20iVqEevZH1nS-QKS-tCkHtFL4ZXioOOitfyVAfuZc3I629AInOtdaqGr5XvVbxPsz36b87UQ_8neCrfjdqCRxIWHw$>
>
>
>
> It’s an observational study of 3.5+ million peds looking at cumulative
> exposure to ionizing radiation, particularly focused on bone marrow dose,
> and increased risk of hematologic cancer incidence. Their results claim an
> increased incidence of cancer in patients with exposure to imaging, and
> demonstrate a cummulative dose effect. They claim their results are not
> likely due to reverse causation as they have reasons for exams and symptoms
> of these cancers were not common reasons for exams. They also note their
> results are inline with the EPI-CT study. Of note, it appears that they
> looked at imaging from 1996-2017 – so much of the imaging likely occurred
> on imaging equipment without many of the modern dose reduction features.
>
>
>
> This is sure to get media play and parents will certainly have questions
> as the media coverage develops. Continuing to focus on the judicious use of
> imaging, the benefits of diagnostic imaging to answer clinical questions,
> and the fact that modern imaging equipment adapts to patient size and uses
> optimized radiation will be key talking points.
>
>
>
> From the paper: “By the end of follow-up, 7.5% (280,548 of 3,724,623) of
> all the children and 9.2% (272 of 2961) of those in whom a hematologic
> cancer developed had received a cumulative dose of at least 1 mGy.”
>
>
>
> <image003.png>
>
>
>
> There is a lot to look at in this paper and the supplemental materials, so
> more information/analysis is sure to come.
>
> --
>
> *Mark P. Supanich, Ph.D., DABR, FAAPM* (he/him)
>
> Director – Diagnostic Medical Physics
>
> Rush University System for Health
>
> Associate Professor & Vice Chair for Physics and Informatics
>
> Rush Medical College Department of Diagnostic Radiology and Nuclear
> Medicine
>
> <image004.png>
>
>
>
>
>
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